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PubMed2006

[Breast Center--a virtual unit for the multidisciplinary care of breast patients].

Breast cancer, the most prevalent female malignancy represents a major health problem. Breast cancer mortality may be halved by high quality mammography screening and care. The most efficient screening and the best treatment of patients are available at the breast centers that are equipped with special facilities, expertise and significant experience via the treatment of a high number of patients. Breast center is a virtual unit based on the collaboration of various professionals; a tight institutional frame is not a must. In these comprehensive centers, 150 breast cancer patients per year at a minimum are treated, and the most efficient special treatment methods are available. The core members of the staff are the breast pathologists, the mammographists, the breast surgeons, the oncologists/oncoradiologists, the breast nurses, the technicians and the data managers. An easy access to the service of the non-core members, the plastic surgeons, the psychologists, the psychiatrists and the clinical geneticists is necessary. An optimal collaboration of the various experts may be achieved by a training of the members, regular multidisciplinary meetings and guidelines developed and accepted by all. The requirements of a breast center have been published by the European Society of Mastology (EUSOMA), and a directory of the accredited European breast centers is maintained. The Breast Unit of the University of Szeged has been found eligible by EUSOMA to be included in the directory of the European breast units. Two mammographists do screening-mammography and clinical examination, 2 pathologists perform cytopathological, histopathological and immunohistochemical examinations. Three surgeons operate on more than 250 breast cancer patients per year, and apply wire or isotope (ROLL) localisation in case of non-palpable lesion. A plastic surgeon is available if necessary. In a half of all cases, sentinel mapping is performed with isotope- and blue dye-labelling. Two radiotherapists apply conformal radiotherapy in 250 cases per year, and 2 oncologists perform modern chemotherapies in 200 cases as a yearly average; 50 new advanced/metastatic cases per year require oncological treatments. Breast nurses, a psycho-oncologist and a mental hygienist nurse assist the team. There is access to lymphedema treatment and physiotherapy. The final goal of the program is to provide all women with high quality mammography screening and care, if necessary.

Breast Diseases↗

PubMed2006

Sharable EHR systems in Finland.

In Finland, the shared record is a virtual electronic health record (EHR). It consists of health data generated, maintained and preserved by different health care service providers. Two different kinds of technologies for integrating regional EHR-systems are applied, but mainly by using a common middleware. Services provided by this middleware are EHR location services using a link repository and combining EHR-viewing services with security management services including consent management and identification services for health professionals. The Regional Health Information Organization (UUMA) approach is based on a stepwise implementation of integrated regional healthcare services to create a virtually borderless healthcare organization--a patient centered virtual workspace. In the virtual workspace multi-professional teams and patients collaborate and share information regardless of time and place. Presently the regional health information network (RHIN) is comprised of three integrated services between primary, secondary and tertiary care within the county of Uusimaa. The regional healthcare modules consist of an (1) eReferral network, (2) integrated EHR service between health care professionals and (3) PACS system. The eReferral between primary and secondary care not only speeds up the transfer, but also offers an option for communication in the form of eConsultation between general practitioners and hospital specialists. By sharing information and knowledge remote eConsultations create a new working environment for integrated delivery of eServices between the health care providers. Over 100,000 eReferral messages (40 %) were transferred between health care providers. Interactive eConsultations enable supervised care leading to the reduction of outpatient visits and more timely appointments. One third (10/31) of the municipal health centers are connected to the clinics in the Helsinki University Central Hospital by the eReferral system. The link directory service extends the dimensions of networking between organizations by combining legacy systems within regional primary and secondary care. The link directory is an interface to diverse patient information systems, like HUSpacs, containing links pointing to the actual patient data located in remote information systems. The original data including images can be viewed with a web browser, but data can be accessed only with the patient's informed consent. Currently the reference data base includes 9.5 million links from 1.4 million patients with over 2.000 daily users. We aim to create a new working environment for professionals by incorporation of innovative information and communication technology, new organization of work and re-engineering of workflows. In the near-future, the citizen will have an active role participating in decisions on his care, carrying out guided self-care and taking steps of pro-active prevention.

Computer Communication Networks↗

PubMed1990

PDQ: the National Cancer Institute's computerized database for physicians.

Physician Data Query (PDG) is the National Cancer Institute's computerized database of current information regarding cancer treatment consisting of four major files: (1) a cancer information file providing prognostic and treatment information on all major cancers; (2) a protocol file containing investigational and standard therapy protocols; (3) a physician directory of 10,000 physicians devoting a major portion of their clinical practices to cancer treatment; and (4) a directory of approximately 2,000 organizations and institutions providing care to cancer patients. While PDQ's primary user group is practicing physicians requiring information for patient care, it can be of use to other health professionals. Searches are rapid, inexpensive, and can be performed through medical and hospital libraries, via individual direct accession, or in conjunction with other online vendors.

MEDLARS↗

PubMed1989

Evolving residency requirements for ambulatory care training for five medical specialties, 1961 to 1989.

Recent changes in the patient population of teaching hospitals, spurred by technologic advances and economic forces, have jeopardized the traditional hospital-based model of residency training. In consequence, there has been increasing attention paid to the need for ambulatory care experience. A primary force in shaping the content of postgraduate medical education is "The Essentials of Accredited Residencies," published in the Directory of Graduate Medical Education Programs. We reviewed recommendations and requirements for ambulatory settings and outpatient experience as specified in the Directory during the years 1961 to 1988 and investigated pending changes in requirements for five major specialties: internal medicine, pediatrics, family practice, general surgery, and obstetrics and gynecology. Increases in the amount of time residents spend in ambulatory care training recently have been mandated in internal medicine and are under consideration in two other specialties, indicating probable major shifts in the locus of postgraduate medical training.

Ambulatory Care↗

PubMed1984

Use of surnames in ethnic research: the case of Kims in the Korean-American population.

This paper introduces a method for estimating the size of the Korean American population in communities in the United States. Since about 22 percent of Korean Americans have the surname Kim and the telephone subscription/listing rate for Korean Americans is extremely high, a fairly simple equation for such estimation can be constructed. The number of Kims listed in the published telephone directory for a community, the mean size of the Kim households, the residence telephone subscription/listing rate, and the proportion of Kims are the factors included in the equation. A specific value for each of the factors has been derived from various "unobtrusive" and nongovernmental sources. Only insignificant differences have been found between estimates made using this method and the enumeration figures from the 1980 census for the Korean American population in the New York metropolitan area and Los Angeles and Orange counties. It appears that the equation is effective in estimating the size of the Korean American population in a community and could be a useful instrument in evaluating the accuracy of the 1980 Census enumeration of Korean Americans. The paper also describes the potential utility of Kims listed in published telephone directories as a sampling frame of Korean Americans in the United States. The ideas and procedures presented here can be extended to other ethnic populations with unique surnames, such as Nguyen for the Vietnamese American population and those starting with "Yama" . . . for the Japanese American population.

Demography↗

PubMed1983

A study of video display terminal workers.

Workers who operate video display terminals (VDTs) are sometimes reported to experience high levels of physical and psychological distress. In an effort to investigate these reports, a study was conducted that compared the responses of 145 Directory Assistance operators who used VDTs to retrieve listings with 105 controls who referred to printed paper directories. The comparison was made on the basis of a single questionnaire that was administered to both groups. The questionnaire asked about the experience of 15 physical discomforts of the sort that are sometimes attributed to work with VDTs. There was only one statistically significant difference in the incidence of complaint: VDT operators were more likely to complain of neck discomfort. On the whole, VDT operators expressed greater satisfaction with their jobs than did operators who used paper records. VDTs may pose special problems, particularly if they are selected or installed without adequate regard for the physical limitations of workers who must use them. Several of these problems are discussed.

Computers↗

PubMed1981

Causes of death among anesthesiologists: 1930-1946.

The causes of death among anesthesiologists from 1930 through 1946 were determined and compared to the causes of death for contemporaneous physicians as well as anesthesiologists in later eras. Names of US white male anesthesiologists listed in the annual Directories of Anesthetists compiled by the International Anesthesia Research Society were searched for in the death files of the American Medical Association. Among those listed in the Directories 274 deaths were located. Causes were ascertained for 269 deaths and 259 causes were verified from death certificates. The leading causes of death of anesthesiologists and other physicians of the same era were cardiovascular-renal diseases and malignant neoplasms. The death rate from all causes was lower among anesthesiologists than among contemporaneous white men and other physicians. Death rates among anesthesiologists from 1930-1946 were similar to those among anesthesiologists in 1947-1956, but greater than those for 1957-1971. Among deaths from malignant neoplasms, those of the digestive organs were the most frequent and those of the respiratory tract the least. Anesthesiologists practicing in the earlier part of this century had lower death rates and they were less likely to die of malignant neoplasms than contemporaneous white men. The death rates for these anesthesiologists were similar to those for anesthesiologists during 1947-1956, but greater than rates observed for anesthesiologists during 1957-1971. This suggests that exposure to the fluorinated anesthetic agents introduced in the mid-1950s may not be an important health hazard.

Adult↗

PubMed1993

Accuracy of indexing coverage information as reported by serials sources.

This article reports on the accuracy of indexing service coverage information listed in three serials sources: Ulrich's International Periodicals Directory, SERLINE, and The Serials Directory. The titles studied were randomly selected journals that began publication in either 1981 or 1986. Aggregate results reveal that these serials sources perform at 92%, 97%, and 95% levels of accuracy respectively. When the results are analyzed by specific indexing services by year, the performance scores ranged from 80% to 100%. All three serials sources tend to underreport index coverage. The author advances five recommendations for improving index coverage accuracy and four specific proposals for future research. The results suggest that, for the immediate future, librarians should treat index coverage information reported in these three serials sources with some skepticism.

Abstracting and Indexing↗

PubMed1995

Retrieval from a large, integrated HIS-database through formal descriptions and SQL.

This paper outlines the realization of rich retrieval facilities and comprehensive data administration in an existing, large, integrated Hospital Information System (HIS) using SQL as a query-language and using a large collection of formal data descriptions stored in the Data Dictionary and Directory System (DD/DS). It is emphasized that the approach to enhance the access to the database is more important than the technology. Nevertheless, the facilities are presented that support non-routine retrieval. The Data Dictionary and Directory System functions as a catalog of the information system. The vehicle that facilitates the communication with the database is an implementation of SQL-in a number of appearances. It is stressed that only full benefit can be gained through a combined action of a large integrated HIS, a complete and correct DD/DS, and strong retrieval functions.

Hospital Information Systems↗

PubMed1977

Use of videotape in occupational therapy.

The use and production of videotapes in occupational therapy are expected to increase in the future. A survey of 54 occupational therapy curricula and 59 hospital-clinics showed that 71 percent of the respondents use videotapes. Of that group, 70 percent produce videotapes for occupational therapy. Forty-six percent of the producers of occupational therapy videotapes make them available to others. Ninety-two percent of the respondents indicated a need for reviews of films and videotapes pertinent to occupational therapy, either in a directory--or a directory, with monthly reviews of new materials in the Occupational Therapy Newspaper or AJOT. A listing of subject areas most needed in a videotape format was also compiled.

Occupational Therapy↗

PubMed1996

To stay or not to stay: factors influencing family practice residents' choice of initial practice location.

BACKGROUND AND OBJECTIVES: This study examined what factors influence US third-year family practice residents' choice of location of their first practice. METHODS: A survey was developed by the members of Northeastern Ohio Network to assess the influence of factors related to family, education, geography, finances, the medical community, and others on the selection of practice location. Surveys were sent to all program directors listed in the American Academy of Family Physicians 1994 Directory of Family Practice Residency Programs to be distributed to all third-year family practice residents. The program directors indicated the type of residency program, the number of surveys distributed, and the number returned, then forwarded completed surveys to the investigators. RESULTS: Two hundred fifty-nine of the 380 programs (68%) with PGY-3 residents responded. Of the programs that responded, 1,012 residents (64%) of a possible 1,578 completed surveys. Estimated from the directory, 812 residents from non-responding programs did not complete the survey for an overall response rate among residents of 42% (1,012/[1,578+812]). Family-related items seem to have the most influence on choice of practice location and are more important to married people. More than 50% of residents want to practice in the same size community in which they grew up. Money-related factors were not rated as highly as expected. CONCLUSIONS: Several factors appear to be important to family practice residents when selecting their first practice location. Hospitals interested in retaining their graduates can maximize their success by concentrating on these areas.

Adult↗

PubMed1997

Detecting and managing elder abuse: challenges in primary care. The Research Subcommittee of the Elder Abuse and Self-Neglect Task Force of Hamilton-Wentworth.

OBJECTIVE: To determine family physicians' perceptions of barriers and strategies in the effective detection and appropriate management of abused elderly people. DESIGN: Questionnaire survey; the protocol included an advance notification letter and 3 follow-up mailings. SETTING: Regional Municipality of Hamilton-Wentworth, Ont. PARTICIPANTS: All active nonspecialist physicians who reported seeing elderly patients in their practices were eligible for inclusion. Fifty health service organization (HSO) physicians were randomly selected from among those listed with the HSO Mental Health Program, and 200 fee-for-service physicians were randomly selected from the Canadian Medical Directory. Of the 189 eligible physicians 122 returned completed questionnaires, a response rate of 65%. OUTCOME MEASURES: Physicians' ratings of the importance of potential barriers in assisting older people experiencing abuse and of the usefulness of strategies for dealing with elder abuse. RESULTS: Physicians identified the following barriers as fairly or very important: denial of abuse, resistance to intervention, not knowing where to call for help, lack of protocols to assess and respond to abuse, lack of guidelines about confidentiality, fear of reprisal, and lack of knowledge of the prevalence and definition of elder abuse. Strategies deemed to be helpful included a single agency to call, a directory of services, a list of resource people, an educational package, guidelines for detection and management, reimbursement for time spent on legal matters, continuing education, revision of fee structure and a central library of resources on elder abuse. CONCLUSION: Although the physicians perceived numerous barriers to their detection and management of elder abuse, they identified many strategies that could be implemented at a local level. Preparation of an algorithm to help physicians is the next phase of this work.

Aged↗

PubMed1987

A computer data base for information on cancer treatment.

The Physician Data Query (PDQ) system is a clinically oriented computer data base developed to make recent information on cancer treatment widely available to the medical community. It represents an effort by the National Cancer Institute to promote diffusion of information about the treatment of cancer throughout the country, facilitate access to clinical trials, and accelerate the practical application of advances in research. The computer system provides information about state-of-the-art cancer treatment, which is updated monthly by an editorial board. It also includes a file of active cancer-research protocols and a directory of physicians and organizations providing cancer care to which physicians can gain access by geographic location as well as other features. PDQ was designed for physicians who may not be familiar with computers, to permit them to search for and display information without learning a specialized search language. PDQ uses a computer mainframe, which allows a large amount of data to be stored and made available to physicians rapidly and accurately. Transmission of information about cancer over commercial telecommunication networks gives health professionals access to PDQ by means of a computer terminal and local telephone lines.

Directories as Topic↗

PubMed1978

Follow-up methods to trace women treated for pulmonary tuberculosis, 1930-1954.

A retrospective cohort study, designed to examine the relationship between multiple chest fluoroscopies and subsequent breast cancer risk, was conducted in which 93.6% of 1764 former sanatorium patients were successfully located. The methodology used to trace former female patients who were treated for pulmonary tuberculosis between 1930 and 1954 (20-45 years before the study began) is presented. Extensive use of city directories and telephone resulted in locating the majority of study subjects. Outpatient medical records and state vital statistics departments were also of value. Searching for death certificates of parents was helpful as the informant named on the certificate was often the woman being traced or her husband. The Postal Service was of limited use. No difference in the proportion of breast cancer cases was found between the more easily traced patients and the last 9.7% of patients who were difficult to locate. Fewer of the last patients located had died, however, than those located without intense effort. Patients lost to follow-up were younger at the time of sanatorium admission, had a higher proportion of Protestants and non-white women, had shorter lengths of hospitalization and had less severe tuberculosis requiring less aggressive treatment than patients located.

Adolescent↗

PubMed1990

The availability of fellowship training for foreign family physicians.

The authors surveyed the 49 U.S. fellowship programs in family medicine listed in the 1988 Fellowship Directory published by the Society of Teachers of Family Medicine. The past experience and future intentions of the 47 responding programs toward non-immigrant foreign family physicians coming to the United States to undergo fellowship training in academic family practice were studied. Only a minority of the programs (22%) had ever trained a foreign fellow, and of these only five of 11 were definitely able to do so in the future. Over half (52%) of the programs that had never trained a foreign fellow stated that they were not prepared to train a foreign physician. Although foreign family physicians are encouraged by the American Academy of Family Practice to come to the United States for fellowships, this study shows that it is extremely difficult for these physicians to find programs willing to act as host.

Directories as Topic↗

PubMed1986

Cardiac arrest and heart attack: an evaluation of lay knowledge.

Random samples of Dunedin residents were interviewed before and after the publication in the telephone directory of an information sheet on cardiac arrest and heart attack. Most subjects had heard of both cardiac arrest and heart attack but almost half of the samples were either wrong in identifying which was the more serious or they did not know. One-third of the post-publication sample had looked at the information sheet. Results indicate limited awareness of all but the most elementary medical facts and the existence of a variety of confusions and misconceptions in the two samples. Problems of comprehension and remembering are discussed in the context of the communication of medical information by doctors and health educators.

Adult↗

PubMed1968

Keeping up with biomedical meetings.

Scientific meetings in the field of biomedicine have increased greatly within the last twenty years. There are a number of information or directory sources which provide data about societies or agencies that sponsor meetings or conferences: bibliographic compilations that are generally retrospective in nature, and reference sources which list future national and international meetings. Nevertheless, bibliographic control of this vast amount of resulting literature is difficult. Examination of 120 currently existing bibliographic control instruments revealed that 28 gave some consideration to conferences and meetings. Four of these instruments covered a total of 1,821 biomedical conferences, demonstrating that there are existing bibliographic control instruments which are attempting to keep pace with the volume of material produced as a result of these meetings.

Bibliographies as Topic↗

PubMed2004

Community resources for the elderly.

There are many, many community resources available for the elderly. Your local Yellow Pages Directory is very helpful, and by surfing the Internet, you can access far more information than is possible to read. Physicians and hospital-based case workers also offer a personal and reassuring touch.

Aged↗